Learning Medicine

Sunday, August 21, 2011

First Week on the Wards

So I've completed my first week on the wards. Lots to report, so little time.

Here is what my day looks like:

5:30 am - Wake up/Breakfast/Shower

6:30 am - Arrive at hospital

6:30-7 am - Pre-round* on my patients
* Prerounding is when you collect information on overnight events and check the vitals and do a directed physical exam. The purpose is to get the data for a progress note.

7 am - 8: Work rounds
This is when we visit our patients with the resident and report what we found from pre-round.

8-9: Some kind of conference; sometimes grand rounds.

9-10:45- Attending rounds
This is a reiteration of what we did earlier on work rounds, but this time with the attending physician. The med students, interns, resident, attending and a team of pharmacists walk to each patient's room and report on their progress or give a full H&P, right in front of the patient. Medicine, I'm finding, is a lot of team work.

10:45 - 12: Pulmonary Rounds
My team on pediatrics covers general, pulmonary and endocrine patients. The pulm rounds cover a whole floor of patients with cystic fibrosis. We do this until lunch. It's rather repetitive since everyone has the same disease, but I'm learning the subtleties of CF management.

12-1: Lunch (conference)
Often there is a noon conference that coincides with lunch. This is a good time to score some free food if there happens to be some.

1-4 PM: ?
Finish progress notes from the morning. Do H&Ps. Study if there is time. The afternoon is a bit nebulous. You tie up loose ends if there are any.

4-6PM: Wait to be discharged by the resident.
I find this time to be particularly inefficient. Unless we're admitting patients, there is not much to do. Yet, for whatever reason, we all just kind of have to hang around until it's time to go home.

6-7: Drive home, eat dinner, see wife.
7-8: Some work/study.

9 PM: Bedtime

If on call, don't come home till 11 PM.

Repeat.

That's my life for now.

I've experienced a lot in one week. I've seen many different patients with a host of diseases. I'm learning how to perform in the hospital setting. I'm less intimidated about giving oral presentations and doing H&Ps. I see ways that I can be helpful to my team. I'm learning 'doctor speak'. My physical exam skills are improving.

Before this week, I was a bit apprehensive; I felt unprepared. Indeed, I was. But there is no way to prepare adequately from books. You just got to get on the wards and do stuff and observe.

Next week will hopefully be better than this past one in terms of my efficiency and learning. I know how things flow in Pediatrics at least. I think I have a better idea of what the expectations of my superiors are and I hope I can be more helpful in the coming weeks.